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TRAUMA THORAXTRAUMA THORAX

INSPEKSI :INSPEKSI :  JEJAS JEJAS  HEMATOMEHEMATOME  RESP.TERTINGGAL.RESP.TERTINGGAL.

PALPASI:PALPASI:  NYERINYERI  TERABA FRAKTUR IGA TERABA FRAKTUR IGA  KREPITASI KULIT A TULANGKREPITASI KULIT A TULANG PERKUSI:PERKUSI:  SONORSONOR  HIPERSONORHIPERSONOR  BEDAHBEDAH AUSKULTASIAUSKULTASI  SUARA NAFASSUARA NAFAS  SUARA CAIRANSUARA CAIRAN  SUARA JANTUNGSUARA JANTUNG

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Diagram shows howDiagram shows howanan unrestrainedunrestrained

driver will sustaindriver will sustain injuries to the chestinjuries to the chest

and head in aand head in acollision withcollision with

frontal impact.frontal impact.

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Diagram showsDiagram shows

how a whiplashhow a whiplash

nec injur! cannec injur! can

occuroccur in a "ac#in a "ac#impact collisionimpact collision

in the a"sence ofin the a"sence of

a head restraint.a head restraint.

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Trauma Thorax

• 25 % multi-trauma

• 25 % kematian trauma• Perlu operasi : hanya ±10 %• Sisanya cukup tindakan

  sederhana

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Anatomi

Tekanan -!

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Anatomi

"ila ca#um

pleura tekananmen$adi positi :

kolaps

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Trauma thorax :

 

&an'sun' men'ancam nya(a

temukan pada primary sur#ey )!

Potensial men'ancam nya(a

temukan pada secondary sur#ey!

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Trauma thorax yan'

men'ancam nya(a : Primary Sur#ey )!

1* +,struksi air(ay

2* +pen pneumotoraks

* Tension pneumotoraks

.* /lail hest kontusio paru

5* asi hematotoraks

3* Tamponade $antun'

Trauma thorax yan'

men'ancam nya(a : Primary Sur#ey )!

1* +,struksi air(ay

2* +pen pneumotoraks

* Tension pneumotoraks

.* /lail hest kontusio paru

5* asi hematotoraks

3* Tamponade $antun'

A

"

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Distres $afasDistres $afasai"at suplai osigen tidaai"at suplai osigen tida

cuupcuup

Frekwensi n!s "enin#k$Frekwensi n!s "enin#k$% & '( ) *n+r",- er,/ +ksi#en& '( ) *n+r",- er,/ +ksi#en

% & 0( ) ##, n!s- sikn n!s */$n& 0( ) ##, n!s- sikn n!s */$n

Gerk 1/in# 2i3/n# 45rin# n+s$ri,s6Gerk 1/in# 2i3/n# 45rin# n+s$ri,s6

Gerk +$+$ ,e2er 4$r12e, $/#6Gerk +$+$ ,e2er 4$r12e, $/#6

Gerk 4re$rksi6 +$+$ se, i#Gerk 4re$rksi6 +$+$ se, i#

Sin+sis 4$n3 ,"*$6Sin+sis 4$n3 ,"*$6

 Tn37$n3 ,in : Tn37$n3 ,in :% n3i 1e$- $eknn 3r2 nik- ri$"in3i 1e$- $eknn 3r2 nik- ri$"i

%

#e,is2 $/ 1+"#e,is2 $/ 1+"

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Dis$resDis$res NN!s!s

Beri +ksi#en $in##i 4& 896Beri +ksi#en $in##i 4& 896

Be*skn ;,n n!sBe*skn ;,n n!s Bersi2kn ;,n n!sBersi2kn ;,n n!s

Beri n!s */$nBeri n!s */$n

A$si ne/"+$+rksA$si ne/"+$+rks

T%$DA&A$

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1* +,struksi  Air(ay :

aniestasi :-'an''uan air(ay-

 4 sesak

 4 stridor 

 4 serak

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1* +,struksi Air(ay Tindakan :

• 6alan naas deiniti 

  intu,asi!• "ila deormitas $elas menekan :

  tarik den'an 7doek-klem8

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2* +pen Pneumo-thorax

9dara pilih masuk

li(at lu,an'tahanan le,ih kecil!

 

an''uan#entilasi

Suckin' chest (ound

aniestasi : "reathin' )

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2* +pen Pneumo-thorax : Tindakan

Tutup ) Pipa toraks - ;S<

Tutup rapat

atau :

=asa sisi

 

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'$(UMOTORA&) T(R*U&A'$(UMOTORA&) T(R*U&A

L/k 3in3in# 33 *is $er*/k s"L/k 3in3in# 33 *is $er*/k s"

sek,i $/ *ersi!$ kn se#er sn# 3rin $+rks

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Se2e,i ,s$ik $iis

Di7,eis$er 0 sisin> J3i k$/* s$/ r2

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* Tension Pneumo-thorax

Pneumothorax Tension >

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+. Tension 'neumo#

thora,

Pne/"+$2+r? Tensi+n Pn.

Insp. : Ekspansi # simetris

 Ausk. : Bs. Nafas satu sisi ↓

Perk. : Hipersonor satu sisi

  Trakea terdorong

  Vena leher distensi

  !ok

aniestasi : "reathin' )

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* Tension Pneumo-thorax

Tindakan :

1*

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T($)%O$T($)%O$ '$(UMOTORA&)'$(UMOTORA&)

Ke#w$n >n# "en#n1" ;iwKe#w$n >n# "en#n1" ;iw Di#n+sis 3i$e#kkn se1r k,inisDi#n+sis 3i$e#kkn se1r k,inis

4$i3k "en/n##/ !+$+ sinr7@64$i3k "en/n##/ !+$+ sinr7@6 3is$res n!s3is$res n!s

n3i 1e$n3i 1e$

2i+$ensi2i+$ensi

en ,e2er 3is$ensien ,e2er 3is$ensi

$r12e $er3+r+n# ke sisi se2$$r12e $er3+r+n# ke sisi se2$ erk/si 2iers+n+r 3i sisi ski$erk/si 2iers+n+r 3i sisi ski$

#erk /3r "s/k#erk /3r "s/k ↓↓ 3i sisi ski$3i sisi ski$

s/r n!ss/r n!s ↓↓ 3i sisi ski$3i sisi ski$

-( A/A

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T($)%O$T($)%O$ '$(UMOTORA&)'$(UMOTORA&) 

Se#er ,k/kn 3ek+"resi 3en#nSe#er ,k/kn 3ek+"resi 3en#n/nksi ;r/" *esr 4-86/nksi ;r/" *esr 4-86

P/nksi 3 se, i# ke 3/ 4ICS '6P/nksi 3 se, i# ke 3/ 4ICS '63 #ris $en#2 se,n#k 4"i33 #ris $en#2 se,n#k 4"i31,i1/,r ,ine61,i1/,r ,ine6

Drin $+rks 3isn# ses/32n>Drin $+rks 3isn# ses/32n>

'($A$-A$A$

P t k t i

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Pneumotoraks tension

Udara masuk rongga pleura dan tidak bisa keluar lagi

Setiap nafas akan memasukkan tambahan udara lagi

Tekanan rongga dada ↑  mediastinum tergeser, VR ↓ dan CO ↓ 

Terjadi distres nafas dan hipoksia

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* *

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Jarum, spuit ! "", air 

Jarum # $ "m

 ia pneu 0123 gelem"ung udara aan ia pneu 0123 gelem"ung udara aan

eluar.eluar.

 ia pneu 0#23 air aan terhisap nafas e ia pneu 0#23 air aan terhisap nafas e

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%ater&sealed

drainage

"m ba'ah air 

Untuk pneumotoraks

Bila ada hemotoraks

( )

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 Di#n+n K- Kw+ J- Bi#$e,,+ LM. P$2+2>si+,+#> n3 "n#e"en$ +! $2e 5i, 12es$. Miner Anes$esi+, '999:07.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgihttp://www.ncbi.nlm.nih.gov/entrez/query.fcgihttp://www.ncbi.nlm.nih.gov/entrez/query.fcgihttp://www.ncbi.nlm.nih.gov/entrez/query.fcgihttp://www.ncbi.nlm.nih.gov/entrez/query.fcgihttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi

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D+r"n T. T2+r1i1 Tr/". F,i, 12es$: $2+2>si+,+#i1 ee1$s n3 in 1+n$r+,. Pr+#r" n3*s$r1$s +! $2e 0s$ In$ern$i+n, E3/1$i+n, n3 S1ien$i1 S>"+si/" +! $2e S+1ie$> +! Cri$i1,Cre Me3i1ine Jn/r> '8709- '99' Sn Die#+- C,i!+rni.

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 T2is ,esi+n is 1,ini1, n3in#- T2is ,esi+n is 1,ini1, n3in#-

n3 resir$+r> 1+"r+"ise inn3 resir$+r> 1+"r+"ise in

5i, 12es$ is "+re $2e res/,$ +!5i, 12es$ is "+re $2e res/,$ +!/n3er,>in# /,"+nr> 1+n$/si+n/n3er,>in# /,"+nr> 1+n$/si+n

n3n3 en$i,$i+n er!/si+nen$i,$i+n er!/si+n

"is"$12"is"$12 $2n $2e 1$/,$2n $2e 1$/,s$r/1$/r, 3e!e1$ $+ $2e 12es$s$r/1$/r, 3e!e1$ $+ $2e 12es$

w,,.w,,.D+r"n T. T2+r1i1 Tr/". F,i, 12es$: $2+2>si+,+#i1 ee1$s n3 in 1+n$r+,. Pr+#r" n3*s$r1$s +! $2e 0s$ In$ern$i+n, E3/1$i+n, n3 S1ien$i1 S>"+si/" +! $2e S+1ie$> +! Cri$i1,Cre Me3i1ine Jn/r> '8709- '99' Sn Die#+- C,i!+rni.

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se#"en$, !r1$/rese#"en$, !r1$/re +! $2e ri*+! $2e ri*

4 ri"4 ri"

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se#"en$, !r1$/rese#"en$, !r1$/re +! $2e ri*+! $2e ri*

+ ri"+ ri"

freefree

6oating6oating

ri"ri"

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.* /lail hest =ontusio Paru

Pernaasan paradoksal?nspirasi @kspirasi

aniestasi : "reathin' )

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.* /lail hest =ontusio Paru

 an' le,ih pentin' : =ontusio Paru-nya

=arena itu : onitor A - "

• 6a'a Air(ay• onitor p+2 dan p+2• +2 100%• Bentilasi tam,ahan

,ila diperlukan  4 "a''in'

  4 Cespirator 

7/A%/ 8H()T7/A%/ 8H()T

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7/A%/ 8H()T7/A%/ 8H()T

Kren $2 $/,n# i# & Kren $2 $/,n# i# &

en$i,sien$i,si ↓↓ kren :kren :% n>erin>eri% #n##/n "eknik n!s#n##/n "eknik n!s%

k+n$/si+ r/k+n$/si+ r/

Beri +ksi#en 4;ik 36Beri +ksi#en 4;ik 36

Beri n,#esi >n# 1/k/Beri n,#esi >n# 1/k/

K/rn#i #erk i# >n# $2:K/rn#i #erk i# >n# $2:% kssi ,eis$er ,e*rkssi ,eis$er ,e*r

% in$/*si $r12e 3n n!s */$n 'in$/*si $r12e 3n n!s */$n '

"in##/"in##/ 

 TINDAKAN

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7lail 8hest

Fikssi ,eis$er ,e*r7 Men#/rn#i #erk r3+ks, >n#"en##n##/ en$i,si7 Men#/rn#i n>eri

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5* assi#e Dematothorax

"ila E 1500 cc

  initial!

"ila E 200 ccF$am

aniestasi : -"reathin'-irculation

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5* assi#e Dematothorax

Tindakan :

• hest Tu,e• "ila massi#e : torakotomi

3 Tamponade 6antun'

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3* Tamponade 6antun'

1*

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3* Tamponade 6antun' : Tindakan

Percardiocentesis

• pasan' @=• darah tidak ,eku )

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Potensial men'ancam nya(a

temukan pada secondary sur#ey!

Serin' :"/raktur ?'a

"Pneumothorax simple"Demothorax ,ukan masi!"=ontusio paru

6aran' :

"Co,ekan pem,uluh darah ,esar "Co,ekan trakea ,ronkus"Co,ekan esoa'us"

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/raktur ?'a/raktur ?'a ::

"atu $e$erapa iga% $iasan!a

 tidak $er$aha!a"Ber$aha!a $ila :

 & Pada orang usia lan'ut(pneumonia)

 & Bila disertai kontusio paru"Tidak memerlukan tindakan

(seperti plester dll)"Bila sangat n!eri  inter*ostal

$lo*k

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Pneumothorax sederhana

Tertutup

•Trauma non trauma•Bila trauma sering ada

  fraktur Iga

  Ter$uka

•Trauma ta'am tumpul

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Pneumothorax sederhana

• mungkin sesak

tidak sesak• terdeteksi pada

pem.fisik dan +"toraks• tidak semua perlu

pemasangan ,-/

H

H

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Bila akan dilakukan tekanan positif :

selalu pasang pipa toraks

Pneumothorax

sederhana

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Demothorax ,ukan masi!

• Terdeteksi pada pem*isik F H-toraks• Tidak semua perlu pipa toraks

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&ontusio 'aru&ontusio 'aru 

Bentilasi tam,ahan :

Ter'antun' keadaan-"reathin'-

-p+2

-p+2

R T * R t T *

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  Ruptur Traea 9 *ronusRuptur Traea 9 *ronus

"ila lu,an' ,esar :• presentasi pada

primary sur#ey

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Ruptur AortaRuptur Aorta

Bila ruptur $e$as  mati

Bila masih tertahan T.ad0entitia :

• e1aktu"1aktu $isa mati• Tanda"tanda lain :

  " s!ok

  " + toraks : mediastinum le$ar 

  " + toraks : fraktur 2 kosta atas

  " tanda lain pada + toraks

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Traumatic Asphyxia

• "iasanya

tidak

,er,ahaya

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